I’m reading through the Task Force on Childhood Obesity report right now. There’s something that’s been nagging at my brain for a while now, and bear with me while I sort it out.

There’s a premise in the “solving the problem of childhood obesity” work that goes something like this: “If we pulled out all of the stops, we could reduce childhood obesity rates to those of the 1970s.” That is, we could make today’s and tomorrow’s children as small as the children of the 1970s. And another premise, which I’ll just quote from the report here: “genes only account for susceptibility to obesity and generally contribute to obesity only when other influences are at work.” This statement may be accurate for some, but for many of us, the only environment in which we wouldn’t have been fat would have been one of starvation — and once we were able to control obtaining sufficient food, our bodies would have grown to the size they were programmed to be.

Here’s what the report says the Task Force on Childhood Obesity is setting out to do:

Our goal is to solve the problem of childhood obesity in a generation. Achieving that goal will mean returning to the expected levels in the population, before this epidemic began. That means returning to a childhood obesity rate of just 5% by 2030. [The rate quoted for 2007-8 is 19.6%]

There’s an important step that was left out in the whole process of putting together this report — and that was this one: “involving those affected by the problem in identifying the problem.”

In my profession (health education), there is a set of ethics. One publication that captures one set of these ethics is the Society for Public Health Education. Section 7 of Article I: Responsibility to the Public states:

Section 7: Health Educators actively involve individuals, groups, and communities in the entire educational process so that all aspects of the process are clearly understood by those who may be affected.

Under Article II: Responsibility to the Profession, we find:

Section 2: Health Educators model and encourage nondiscriminatory standards of behavior in their interactions with others.

And under Article V: Responsibility in Research and Evaluation, this section is of note:

Section 1: Health Educators support principles and practices of research and evaluation that do no harm to individuals, groups, society, or the environment.

So I ask: How do we know which children are those who would have been fat in 1970 — and how do we, following the ethical guidelines listed above, make sure we are not harming them or any other children or adults in the process?

Many of the actual strategies for improving access to healthy food and movement do sound like, in a good way, rolling back the past 40 years of damage done to things children need to be healthy. I support them. But when it comes to the surveillance of children (individually and population-wide) by measuring BMI, I think there are huge risks to consider. And there hasn’t yet been a consensus that getting to 5% by 2030 is an attainable or worthy goal. There are other things being measured, to which I say, good. And I would predict that they could see a generation of healthier children (some of whom will be “naturally fat”) by implementing these plans, a side-effect of how this will be measured and tracked could be to the detriment of the mental health of many children.

I’ll be digging deeper into the report and I’ll report back here. In the meantime, please try not to lose or gain any weight (or let your children do so) until the baseline has been measured!

Thanks for digging into this further. I totally agree (as an MD and childhood feeding specialist) that BMI misuse is an invitation to harm.
Haven’t children in general gotten heavier and taller in the last 50 years? Are the BMI charts keeping up with these changes? (I read a piece by Jon Robison about the harms of labeling and he mentioned that the charts being used are not updated and further effect our interpretations.) Steady growth is likely healthy growth, big or small.

Katja, I love your blog and your perspective. If I wasn’t writing in such a hurry, I would have written about how you’ve influenced me!
I think that what MDs might want to look at instead of BMI (and these could be other public health surveillance tools as well) would be things like the frequency of family meals, the frequency of pleasurable physical activity, the overall makeup of the diet.
There’s a lot of room for improvement in what children eat, and I am so much in favor of children playing more, including physically active play (I just came from a parent-child dance class) and less “screen time” overall.
Of all of the interventions being proposed, the BMI tracking one is the only one I really have any beef with. The others are good, I just wish they weren’t under the childhood obesity umbrella.

i was talking with my mother about my eating behavior out of the womb. In 1966, I was screaming for food every two hours. I was at 6oz of formula when I left the hospital, mom says 2oz was the norm. I ate ferociously at every feeding.
I came out of the womb with an exceptional hunger regulation. I am not schooled on these things, but in a post obamalictic world I fear I would feel as if I was starving if my formula was limited by government edict.